1 prep football season, 1,800 hits to the head

New study warns of undiagnosed brain injuries in high school players

October 05, 2010|By Rex W. Huppke, Tribune reporter

We can see it — maybe even feel it in our teeth — when the Chicago Bears' Jay Cutler goes down with a concussion after being sacked nine times or a local high school player is pulled from a game after a vicious shot to the head.

But a new study of an Indiana high school football team hints that some athletes are suffering brain injuries that go undiagnosed, allowing the players to continue getting battered, unaware of the possible cognitive damage that has been done.

Of 21 high school players monitored for a full season by a team of researchers from Purdue University, four players who were never diagnosed with concussions were found to have suffered brain impairment that was at least as bad as that of other players who had been deemed concussed and removed from play.

"They're not exhibiting any outward sign and they're continuing to play," said Thomas Talavage, an associate professor at the Weldon School of Biomedical Engineering at Purdue and the lead researcher on the study. "The cognitive impairment that we observed with them is actually worse than the one observed with the concussed players."

The report, published in the latest edition of the Journal of Neurotrauma, found that some players received more than 1,800 hits to the head during practices and games, some with a force 20 times greater than what a person would feel while riding a roller coaster.

The potential long-term impact of jaw-dropping collisions in sports has become a hot-button issue this NFL season. In the first week alone, four players sustained concussions, including starting quarterbacks Kevin Kolb of the Philadelphia Eagles and Matt Moore of the Carolina Panthers. The Bears' Cutler suffered a concussion Sunday night against the New York Giants, and it remains uncertain whether he'll be cleared to play this weekend.

But the Purdue study shines a light on injuries more insidious than full-blown concussions, ones that don't always result in outward symptoms yet could add up to cause serious long-term cognitive problems.

Hunt Batjer, chairman of the department of neurological surgery at the Northwestern University Feinberg School of Medicine and co-chairman of the NFL's Head, Neck and Spine Committee, said the Purdue study — which he was not involved in — is timely, as many researchers are now debating what is more damaging: the intensity of an individual hit or the cumulative impact of repeated collisions.

"This is part of what we're trying to do at the professional level, to determine at what level does further trauma to the head result in potential neurological damage," Batjer said. "There could be changes that may not affect the player now but might affect them 10 or 20 years later. Those thresholds just aren't known."

He noted that an autopsy on Cincinnati Bengals receiver Chris Henry, who died in a domestic dispute last year, found that he suffered from chronic traumatic encephalopathy, or CTE, a brain disease caused by repeated brain trauma. But the receiver reportedly had not suffered concussions in his collegiate or professional career, indicating that the head injuries — like those found in the Purdue study — didn't rise to the level of a clinical diagnosis.

"On a daily basis, there's no effect these guys are going to observe, really," said Talavage, the Purdue researcher. "There's no immediate deficit. But what we are concerned about is that there have been a number of reports of NFL players and former college players who have shown scarring on their brains even without concussions, and we know that you can develop CTE without having a history of concussions. So the question from our study becomes, 'Are we seeing a possible explanation?'"

Talavage and his team conducted their research by placing monitoring equipment inside the helmets of players at Jefferson High School in Lafayette, Ind. They did baseline tests on each player before the season, invited several players in for additional tests each week and then conducted a postseason assessment of the subjects.

Four of the 21 players were diagnosed with concussions during the course of the season. But what surprised the researchers was that four players who showed no symptoms of concussion had significant performance drops on routine cognitive tests. Brain imaging tests also showed decreased activity in the parts of the players' brains associated with working memory.

"We were not expecting to find them, they just kind of popped up," Talavage said. "When you talk to players in this group, there's no outward sign. Yet here we are finding changes in testing scores and changes in their brain metabolism that show something that we're a little worried about."

Three of the four players were linemen, and one was a wide receiver. Talavage said that because the research is ongoing, none of the four players has been told about the brain scan results.